The Football Concussion Crisis

NFL Hall of Famer Harry Carson joins former NBC anchor Stone Phillips and pathologist Bennet Omalu for a discussion of chronic traumatic encephalopathy among football players. Recorded May 12th at the Ensemblestudiotheatre.org, site of the new play Headstrong about the brain injury issue

Carson: The public has not sat up and took notice until Junior Seau, because he is a more contemporary player that people know.

Steve: Harry Carson, former New York Giants middle linebacker and member of the NFL Hall of Fame. And I'm Steve Mirsky, and this is Science Talk, the podcast of Scientific American posted on May 15th, 2012.

Carson: But there are other players who have committed suicide and no one really cared. Ray Easterling committed suicide; he wrote me an e-mail, March 18th of last year, and it was really a cry for help.

Steve: Carson is obviously talking about the NFLs concussion crisis, the head trauma faced by players has been a subject of discussion for years now, but it really exploded into the public consciousness with the death of twelve-time Pro Bowler Junior Seau, who took his own life on May 2nd. Meanwhile, here in New York City, the Ensemble Studio Theater, with funding from the Alfred P. Sloan Foundation, has been running a new play called, Headstrong. The play by Patrick Link, illustrates the head trauma situation through the story of a woman whose husband, a former NFL running back, has committed suicide. It's loosely based on real cases of former players and its run has been extended to May 27th. On May 12th, following a performance of Headstrong, the theater hosted a panel discussion moderated by former Dateline NBC anchor, Stone Phillips. Also taking part was Doctor Bennet Omalu, the pathologist who first identified what's become known as CTE, chronic traumatic encephalopathy in football players after his autopsy of former Pittsburgh Steeler Mike Webster. Here’s an edited version of that conversation. There's a short section with some loud background noises; that's just a group of people leaving the building through a stairway adjacent to the theater; it lasts for about 30 seconds. We start once again with Harry Carson.

Carson: You know, I've been following the whole traumatic brain injury head-banging concussions issue for years and years and years, only because I was diagnosed back in 1990 with post concussion syndrome. And so I started sitting on panels talking with various groups with the Brain Injury Association, and really learning about the subject, and when you get that first-hand knowledge—and there wasn't a whole lot of information out there when I was first diagnosed—when you start to live with it, when you start to experience your own issues, then you become your own guinea pig. And so I could very much identify with a lot of what took place in the play, not just from my own perspective, but what I know of what other players have gone through. Because Mike Webster was a friend of mine, and in his last days, I knew something was going on him with him; even though he had been turned down for disability with the NFL, I knew something was going on with him. And so I flew to Pittsburgh to be at his funeral—I was the only non-Steeler there—and I spoke with his son, and he shared with me what he was going through. So, this is something that has really been going on for quite some time. I think had it not been for the Internet, a lot of what is going on now would still be unknown. Because with the Internet people have been able to communicate with one another, to share their stories, and I give thanks to many of the wives, because the wives have talked to one another about the issues that have affected their husbands.

Phillips: You mention Mike Webster. This was a very influential event—his death—in inspiring you to want to investigate this, is that right?

Omalu: Well, what happened was, it was 2002 in September, but I have been intrigued by the game of football because I have grown up in Africa—I played soccer (laughter) . And I saw the game of football as a game where people dressed up like extraterrestrials (laughter), running around a field. But something really puzzled me: Why did they have to dress up in such protective gear? Especially the helmet. I did not understand why. But I had also been wondering, what is so called post-concussion syndrome, so called PTSD syndrome, which all had one diagnosis that did not mean anything, but could there actually be a pathologic basis for such nondescript diagnoses? And I had read that many football players after retirement from football don't do well; they don't compete so well as they had competed at the field of football. So these were all hypotheses, innuendoes, inferences in my mind, until one Saturday morning. It was a Saturday morning, I was scheduled to work as a forensic pathologist; I performed autopsies. I turn on CNN, and they were talking about this great football player who had played for 17 years; one of the greatest centers that had ever played. He died suddenly. And before his death he was living in a railway station, lost all his money, sold all his Super Bowl rings, peed one day, on a Thanksgiving day after dinner in front of the oven believing it was a bathroom, and was shocking himself with a Taser because he was chronically and persistently depressed. So, while they were bashing him on TV, football players don't do so well, it struck me, "I said wait a minute, wait a minute—isn't football the game where they wear helmets and run around? (laughs) Couldn't he have suffered consequences of repeated blows to the head?" When I got to work, there was so much activity, TV vans; and I came in quietly, nobody knew who I was. I said, "What is the commotion?"; they said, "Oh Mike Webster is on the autopsy table"; I said who is Mike Webster?" Suddenly everybody looked at me (laughter) like I was from outer space. They said, "Oh you don't know Mike Webster?" I said, "Who is he?" I said, "Oh he's that guy on TV?" They said, "Yeah, at least you know that one." So, I changed, I approached his body with pure scientific objectivity. I was not performing an autopsy on this great football player. I was performing an autopsy on somebody who was an intellectual curiosity to me. I did the autopsy, I examined his brain—guess what? His brain appeared normal. He had been to Cleveland Clinics, he had been to John Hopkins and all the top neurologists in the country, in the world. They concluded his brain was normal, because the conventional CT scans and conventional MRIs were normal. So I took out his brain, I examined his brain, I spent six months on Mike Webster's brain—six months—until finally, I was convinced it was a new disease. But I had to give it a name, and I had to give it a name with a good acronym, so even the high school student on the street could remember it—CTE, Chronic Traumatic Encephalopathy. And finally I submitted it to The New Surgery Journal, which was the journal where the NFL doctors published their papers. What I said to the NFL doctors then—because they actually wrote a paper, and said my work should be retracted, it was fraudulent.

Phillips: So there was an effort on the league's part to discredit you?

Omalu: Oh yes, yes—even today, as we speak, to control me.

Phillips: Because you named the disease, because you found the physical evidence of the disease and made that correlation and connected it to repeated hits on the head?

Omalu: Yeah, and it was indisputable, unquestionable evidence. And what happens was, there was Mike Webster and within two years was there was Terry Long; within a year there was Justin Strzelczyk within a year it was Andre Waters, then there was Chris Benoit. So by the eighth case I had, there was no other doctor on the face of the earth who had described this disease. And that meant Omalu was a trouble maker. But to cut this whole story short, so today it is very well established, you know—any doctor, who says CTE is not for real is a joke.

Phillips: Harry Carson—what is your response to this story?

Carson: Well, I certainly was following what was going on with him because quite frankly—you know, I wrote a book called Captain for Life, in that book I talk about playing against Mike Webster, and Mike Webster was one of the strongest men in the NFL. And so I knew every time I had to go up against Mike Webster, as a middle Linebacker, I had to load it up, and it was power against power. And some of the shots that I gave him and he gave me; you know, I hit him with my forearm, as he exploded off the ball, and I had to hit him right in the face, and I had to give it all of the force that I could, get him off of me, go and make the tackle. And I knew that if I hit him with such force, he was going to feel it, and that's why I knew that when he was exhibiting all of this abnormal behavior after football, I knew something was wrong. And so, and I also knew that the NFL at that time said there's absolutely no correlation, there is no connection between what a player does and what happens to him after the game and those ailments.

Phillips: And that's the position a league continued to hold until about a year ago.

Carson: For years and years and years, until they got pulled before Congress and Congress skewered them; and their doctor was not there to testify, and so they got called on the carpet; it was at that point that they had to acknowledge that there could be a correlation, and they started putting posters up in locker rooms all around the country to say that if you sustain a concussion, it could lead to Alzheimer's, ALS and dementia.

Phillips: And depression, and the personality changes and…

Carson: Well, they don't go into such detail in regards to that (laughter) , but you know, there have been players who were great players, who, once their careers ended, they just wallowed after their careers ended. They didn't know how to get back on track. And these guys weren't dumb guys. You cannot be a dumb guy and play in the National Football League; you can't. There's so much information that you have to know. It's 80 percent mental and 20 percent physical. All people see is the physicalness of the game; it is so mental , that's the thing that gets the guys cut more than anything else—the mental mistakes. And when these guys cannot adjust to life afterwards, and when they get into these bouts of depression, and when they start exhibiting abnormal behavior, there's something going on. And you know, they need to get some kind of treatment, be diagnosed and you know, find out exactly what's going on. But the NFL definitely stonewalled him, and you know, they said, "He doesn't know what he’s talking about blah blah blah." When, you know, I knew—and the other thing with Mike Webster is he filed for disability. The NFL fought it, and not only did the NFL fight it, the NFL Player's Association—the body representing the players—joined with the NFL, and they lost. And they lost against a player, who had no place to turn. And I knew all the stories about urinating in an oven, and when you get to that point—and Mike was such a proud player and he lost his dignity. And that's the thing that irritates me and makes me angry. You never want a player of that magnitude to lose his dignity.

Phillips: Voices are being joined now. We're hearing from a lot of players. Harry, I've spoken to a lot of former NFL players, just in the research that I've done, who—many of them publicly talking about it, many of them privately talking about it—but really struggled with all kinds of the symptomatology of CTE. I was going to ask you, doctor, what is going on inside their brains? For those, I mean, can you give us a picture of what's going on, I mean, for the—obviously, it has to be diagnosed postmortem, is that correct, you can't…?

Omalu: Actually, we've been working on this. There's a very, very good, almost 95 percent chance, that we've identified, a way to diagnose it in the living; that will be announced hopefully in a couple of months. Some smart guy someplace else, discovered a protein that you can inject into blood and use it in positron emission tomography.

Phillips: Is it the Tau protein?

Omalu: Yes. Based on what we have identified, it would be easy for us to study. So the PET will light up, resembling the topography of the brains we have examined. So luckily, maybe in a matter of months, we will announce it, and we will recruit more players. So the answer boldly to that is: Yes, we have finally identified ways to identify it in the living.

Phillips: And how is that done? Can you talk about it?

Omalu: I wouldn't talk about it really now but it's a true, very specialized, highly advanced radiological methodology—nuclear medicine. And again, just examining a dead brain, it's not just examining dead tissue. Most advances in medicine we have today were derived from autopsy, studying autopsy tissue. And I was worried because—it was very critical—if the NFL had succeeded in stopping me from doing what I was doing, it would have been bad for science generally. And so there's great value in forensic medicine—studying deceased tissue and dead people to apply what we know to living people—it's called translational medicine. And even when you suffer an impact—because I also do other brains that are not football brains—when you have suffered an impact, there are abnormal proteins that accumulate in your brain, one to two hours after the impact, even relatively innocuous or a seemingly innocuous blow. So it's not just about concussions. Every impact you receive on your head, there are abnormal proteins that accumulate, and this abnormal protein will clear after about three months. But when you keep on receiving the blows, the abnormal proteins will not clear. So after a while, the abnormal proteins, abnormal enzymes will act on the abnormal proteins and will lead to the accumulation of Tau; this is very well established. And I am telling again this is not just about football; this is about any human activity that results in repeated acceleration, deceleration of the brain. And no helmet, I repeat, no helmet can stop your brain from suffering acceleration-deceleration following an impact. We're beginning to see CTE in military veterans returning from Iraq and Afghanistan, who have committed suicide because of the repeated exposure to ordinances—the pressure wave and the shockwave, they also cause repeated acceleration-deceleration. So, in a football player for example, a professional football player, by the time, you've played in high school, and played in college, there was a paper that was published late last year, a professional football player has had about 8000 hits to the head—8000; about 4000 in high school and 4000 in college. There's no way possible that wouldn't bring lasting permanent damage to the brain site.

Phillips: Harry can you speak to your own experience with concussion? I know you've done this publicly and talked about some of the ways in which you have struggled with some symptoms that have been present.

Carson: Well, you know, I got drafted to play here with the Giants and playing middle linebacker, which is at the time, it was a position normally reserved for white guys because white guys, you know, it's a thinking man's position, (laughter); but you know, that's what it was referred to as—a ‘'thinking-man's position', because in essence, you…

Phillips: You're the quarterback of the defense.

Carson: The quarterback of the defense. And so there were positions normally reserved for black guys and there are positions normally reserved for white guys, and the middle linebacker position was traditionally a position reserved for white guys, because they had to make the calls, make all the changes and everything. And I had been a down defensive lineman at South Carolina State, and Marty Schottenheimer had drafted me and brought me in and taught me how to play middle linebacker. So I was able to master the position, and after about my fifth or sixth year, I recognized that I was having some issues, because not only did I play here—this is the media capital of the world, and there were times when I had to give interviews, whether we won or lost, and I had to go before the media. And I was having problems articulating what I wanted to say, and that was my first sense there's something going on here, when I was searching for these words that I learned when I was in high school, but I had lost the ability to speak the way that I grew accustomed to speaking.
'Phillips: Very out of character for you.

Carson: Very out of character.

Phillips: Right.

Carson: And I remember, I lived in Ossining up in Westchester, but I had to drive all the way over to Giants Stadium, and so I started listening to words on tape to re-familiarize myself with certain words. And I knew something was going on but I didn't share it with anyone else because football players tend to be very private, closed individuals. You don't share your weaknesses with anyone else because that person that you share your weakness with, next week, he'll be on another team, and he's going to share with his team what your weaknesses are. But whether it was the inability to recall words that I wanted to use, or there were times when I felt depressed for no apparent reason—it's well documented that I had thoughts of driving off the Tappan Zee Bridge. But had it not been for my daughter, you know, she was my saving grace—and on and on and on. You know, I'd have headaches for no apparent reason, I'd be dealing with depression and any number of things. Football players are trained to be physical, and you know, you're familiar with knees and the ankles and the hips and the shoulders and everything else, but we’re not trained to recognize what's happening from a neurological standpoint. It wasn't until, I knew something was wrong, but I couldn't right put my finger on it because it wasn't physical, and it wasn't until two years after I left football that I got diagnosed, and the reason why is, I was doing television, and I would lose my train of thought live on the air, which is really a no, no, when you're on television.

Phillips: Tell me about It. (laughter)

Carson: Yeah and, you know, I was talking with my doctor and, you know, I took my yearly physical, and he'd say, "Everything is fine, you know, is anything else going on?" And I'd say, "No, everything is good." And I was about to walk out of the office, and he asked, "Are you sure?" And I said, "Yeah, I've been having headaches and blurred vision, I've been having tremors in my arms and all of this stuff." And you know, he said, "Well, I think we should refer you to, you should see a specialist." And I started not to go, but I went to the specialist, I went through two days of testing, and the diagnosis came back as a mild post-concussion syndrome. And it was deemed to be permanent in nature because it had been over two years since I had hit anyone or anyone had hit me, and it was brought on by football. And so over the years, I've learned, I too, I don't have as many degrees, and I don't think I'm as smart as you, but you know, I've learned that concussions can happen on the practice field. Concussions, as you're hitting the eight-man sled or the seven-man sled, when you explode into the sled and then you recoil, you know, and then when you recoil and then you see stars and everything fades to black, you know I liken that to a concussion. So, I've never really been knocked out, but I know that, you know, I've been hit so hard, and I've hit other people so hard that I saw stars. And so, you know, those are the issues that I've dealt with. I've learned about over the years and, you know, like the doctor said, people talk about the helmet—you improve the helmet, you know, you'll decrease the risk of concussion. That's not true. Because the brain being encased in that fluid, and when it hits up against the inside of the skull, that's when you sustain damage.

Phillips: So what does that mean? Is the study of CTE ruining the sport—a line from the play, a discussion that the characters were having. I mean, Harry let me ask you about that. I mean, is the acknowledgment of this kind of damage that's happening as a result of what is not incidental in football, but is deliberate in football; I mean, football is a game of hitting and you can't take the head out of the game. You can legislate to minimize it, but it's impossible to take it out.

Carson: No you can't take it out, but I think it's important that every parent, who has a child who wants to play football should be informed as to what they're signing their kids up for. They should know what happened with Congress and the NFL a couple of years ago; they should know what happened to players who have gone the route of a Dave Duerson, or possibly a Junior Seau. And to be honest with you the with the number of players, who have committed suicide, the public has not sat up and took notice until Junior Seau, because he is a more contemporary player that people know. But there are other players who committed suicide and no one really cares. Ray Easterling committed suicide three or four weeks ago, and nobody really knew him. He played in the ‘70s and, you know, he's considered an old guy who probably, you know, was having hard times. But he wrote me an email March 18th of last year and he laid out, you know, what he was experiencing, and it was really a cry for help. And so when you see these guys, my wife will tell you, I get phone calls from wives of players who are dealing with dementia. I get phone calls and emails from mothers of sons who played high school ball, and they're no longer the young men that they thought they were going to be because of concussions that they have sustained. Football—you assume the risk from a physical standpoint. Everybody knows that if you play football, you can get hurt. You know, you see them carrying people off the field, they know from a physical risk standpoint; we all assume that risk and we play. But nobody tells you about the neurological risk that you subject yourself to when you play football. Nobody. No coach told me, you know, no player told me, no trainer, there was no information there when I played back in the ‘70s and ‘80s.

Phillips: Which brings us to where this story is headed. You mention it is a hot button issue, but this is headed into the courts. Lawsuits have been filed. Players are filing suit claiming that the league and doctors did not let them know about the risks involved, even when it was apparent. What is your take on these lawsuits?

Carson: I'm very much aware of the lawsuits; I have not opted to be a part of any lawsuit. And, you know, there are guys who I talk with, and they've asked me, you know, "Should I join in the suit?" And I say, "Yes." There were law firms who approached me two years ago, because they saw this coming, and they wanted me to be the lead complainant because I've been talking about this thing since like 1993–1994.

Phillips: Really one of the first to do so.

Carson: Yeah, yeah. And I have not opted to be a party to it, and the reason why is—and you know players have asked me, "Why haven't you opted to be a part of it?" Because the message that I carry with me, I don’t want it to be tainted; I don't want anyone to say, "Well, he's only suing because he wants money; that's the reason why he is talking about the whole issue of concussion." If you ever go and you read something about a former player's demise; and if it's online, you read the comments made by fans after they've read everything, they will say, "Well he knew what he was getting into. They paid him the big bucks, and he assumed that risk and why should you feel sorry for him." He didn't know. I'm telling you, these players when they played, they did not know. Players now, as of two years ago, they know, but those players who played before two years ago, they didn't know, they didn't have any idea of what they were getting themselves into.

Phillips: You know, I'm almost afraid to admit that I played Ivy League Football (laughter). I had a concussion in high school, I had a concussion—and I played linebacker in high school and then played only as a quarterback in college—but after my second concussion, the last game of my senior year in college, I was being looked at by the neurologist, the doctor at Yale, and he asked me if I had any aspirations of going onto play, and I said, "No, I don't" And he said, "Good, two concussions is enough." And one of the reasons I started tracking this story as a reporter is because, you know, I have been astounded to hear over the years that this player has had 15 concussions, that this player has had 19 concussions and continued to play; and I've always wondered—I'm told after two to hang it up, and I always wondered what kind of diagnosis is this, how can they be cleared to play after that many concussions?

Carson: I don't think anyone probably knew that they were concussed. You know, players, when you start playing and everybody here; I mean, if you've got a child who plays, and they went out and they got knocked down, first thing they do was they started crying, right? What do you hear? Well, you know, "You're a big boy aren't you? You know, big boys don't cry, you know; get back in there." You know, and so you're encouraged to play through pain, play through injuries and be a big boy. And when you get back in there and you hit somebody, then it feels good to you to hit somebody and not get hit, and it's about survival. And then you go from there to Pop Warner, and you go from Pop Warner to high school, there are many who play the game in high school because that's the only way that they're going to get to college, is on a scholarship, so they play. And if they sustain a concussion, if they're not knocked out, they're not going to acknowledge it, because they're going to be pulled off the field.

Phillips: Would you let your child play football?

Carson: My sons, my two sons did play to some extent, but I was one of those parents at that time, who said, "Well I'm not going to dictate what I want them to do. I want them to make up their own mind as to what they want to do."

Phillips: And if you were facing that decision today?

Carson: I have a grandson, and my grandson is two, and I've already had the conversation with my daughter. We have established, he's not going to play football.

Steve: That's the end of part 1. Tune back in for part 2 of the conversation with Harry Carson, Doctor Bennet Omalu and Stone Phillips. For more information about the play Headstrong, go to the Web site http://www.ensemblestudiotheater.org